四肢慢性骨髓炎患者金黄色葡萄球菌感染流行病学特征及其预测

Epidemiological characteristics and predictors of Staphylococcus aureus infection in patientswith chronic osteomyelitis of the extremities

    摘要
  • 摘要:
    目的 分析四肢慢性骨髓炎患者金黄色葡萄球菌感染的流行病学特征与其预测因素，为临床制定精准化的经验性抗感染策略及围手术期管理方案提供参考。
    方法 回顾性分析解放军总医院骨科医学部2021年1月－2024年6月收治的201例四肢慢性骨髓炎患者的临床资料。按病原学结果分为金黄色葡萄球菌组、其他菌组及培养阴性组，对年龄、性别、BMI、病程、基础疾病骨缺损体积、实验室检查结果等指标因素进行组间比较，并采用二元logistic回归分析明确金黄色葡萄球菌和血培养阳性患者的血清学预测因素。
    结果 共纳入201例患者，平均45岁，男性148例。共培养分离病原菌194株，其中金黄色葡萄球菌56株（28.86%）。三组患者年龄、性别、BMI、病程、高血压、糖尿病、慢性肾病、肝炎、冠心病、吸烟史及骨缺损体积、C-反应蛋白与降钙素原水平差异无统计学意义。以金黄色葡萄球菌感染为结局的回归分析显示：单因素分析中白细胞计数≥10×109/L、红细胞沉降率≥20 mm/h与金黄色葡萄球菌感染相关（均P＜0.05）；多因素分析校正混杂后，白细胞≥10×109/L（矫正OR=2.777，95%CI：1.046～7.379，P=0.040）和红细胞沉降率≥20 mm/h（矫正OR=2.244，95%CI：1.166～4.319，P=0.016）仍为独立预测因素。此外，红细胞沉降率≥20 mm/h是培养阳性患者的预测因素（矫正OR=2.017，95%CI：1.046～4.164，P=0.037）。
    结论 四肢慢性骨髓炎患者中金黄色葡萄球菌感染比例较高。白细胞与红细胞沉降率可预测金黄色葡萄球菌感染，能为临床短时决策与经验性抗菌治疗提供参考。

     

    Abstract:
    OBJECTIVE  To analyze the epidemiological characteristics and predictive factors of Staphylococcus aureus infection in patients with chronic osteomyelitis of the extremities, and provide a reference for developing precise empirical antibiotic strategies and perioperative management plans.
    METHODS  A retrospective analysis was conducted on the clinical data of 201 patients with chronic osteomyelitis of the extremities admitted to the Department of Orthopedics, Chinese PLA General Hospital, between Jan. 2021 and Jun. 2024. These patients were divided into three groups based on the etiology results: S. aureus group, other bacteria group and culture-negative group. The groups were compared regarding age, sex, body mass index （BMI）, disease duration, bone defect volume, comorbidities, and laboratory parameters. Binary logistic regression analysis was used to identify the serological predictors for S. aureus and blood culture-positive patients.
    RESULTS  A total of 201 patients （mean age 45 years, 148 males） were included. A total of 194 strains of pathogenic bacteria were isolated from the cultures, including 56 strains of S. aureus （27.86%）. No statistically significant differences were found in age, gender, BMI, disease duration, hypertension, diabetes mellitus, chronic kidney disease, hepatitis, coronary heart disease, smoking history, bone defect volume, C-reactive protein and procalcitonin levels among the three groups. Regression analysis with S. aureus infection as the outcome showed: in univariate analysis, white blood cell count ≥10×109/L and erythrocyte sedimentation rate （ESR） ≥20 mm/h were associated with S. aureus infection （both P＜0.05）, and after adjusting for confounding factors in multivariate analysis, white blood cell count ≥10×109/L （adjusted Odds Ratio OR = 2.777, 95%CI: 1.046−7.379, P=0.040） and ESR ≥20 mm/h （adjusted OR=2.244, 95%CI: 1.166−4.319, P=0.016） remained as independent predictors. In addition, ESR ≥20 mm/h was a predictor for patients with positive cultures （adjusted OR=2.017, 95%CI: 1.046−4.164, P=0.037）.
    CONCLUSIONS  S. aureus is a prevalent pathogen in patients with chronic osteomyelitis of the extremities. Elevated white blood cell count and erythrocyte sedimentation rate are independent predictors of S. aureus infection. These readily available indicators can inform rapid clinical decision-making and guide empirical antimicrobial therapy.

     

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